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Saturday 2 May 2020

Crap Chinese tests and OCD

Just two observations this morning - one critically important, the other of minor interest. The first of course is the news that the WHO has been talking bollocks, as they say. Even after their early failings, their palpable negligence, their misdirection to the world at the behest of their Chinese masters, one still paid some regard to the warnings and advice of the WHO. The most frightening of their warnings a week or so ago was that mankind might not develop immunity to the Wuhan virus. This was based on a number of cases in which those who had recovered from Chinese flu were subsequently tested positive for a second time. As the speccie reports, it turns out this was due to faulty and inaccurate testing. "Ah sorry lads" says the WHO "as you were. Turns out these crap Chinese test kits are all duff haha". This just reinforces a resolution on my part to deal with anything that comes out of the WHO in future as I do a K-Tel advert. Their claims may be true, but I wouldn't bet on it.

The second is one of those tiny nuggets that sometimes manage to penetrate the woke blather that the World Service has become, in this case the testimony of an American OCD sufferer who has been wholly vindicated by the Wuhan virus. For years he's been disinfecting door handles touched by others, maintaining infection-free distances and cleaning, bleaching, disinfecting, wiping and mopping from dawn to dusk to keep the microbes at bay. There was a touch of validated pride in his voice as he proclaimed that he was right all along, and the entire world is just catching up with him. More poignantly and realistically, he said that we now all know the anxiety he's suffered all his life, at people breaching social distance, at being forced into microbial risk situations, at people coughing. Every cloud, as they say. The world's OCD sufferers can now behave as their instinct drives them, masked, gowned and gloved, armed with Isopropyl alcohol sprayers and boxes of tissues, wholly unselfconsciously and free of public ridicule. Even the bloody virus can do some people a good turn.

Thursday 30 April 2020

Snake oil and miracle drugs

Science is galloping along at a healthy pace, thanks to the Wuhan virus. All over the world, medical and pharma researchers and practitioners are working with unprecedented focus on drugs to alleviate the symptoms of the virus or for a vaccine. The internet has enabled them to put their findings out in public instantly, many without peer review, and wholly by-passing the filtering and partiality of the medical establishment and the gatekeepers of the learned journals. I expect like me you will delve into the Pubmed site maybe once a week to see how they're all getting on, even if, also like me, a lot of the science is over our heads. And doctors themselves have established unofficial, unsanctioned 'Whatsapp' groups - at no cost whatever to the NHS, and not a single NHS £100k manager to administer them - to share clinical information.

Overnight, this eager and industrious research has overturned the shibboleths of the medical establishment; ventilators, it appears, are a very bad thing. Even if you're unlucky enough to be ill enough to be taken to hospital, where you have a 90% chance of surviving, it falls to 50% if they put you on a ventilator. And if you smoke, keep smoking. As more and more research and data is shared freely online, so the world will learn how best to care for those who fall seriously ill from the Wuhan virus, the most effective prophylactics and the best drugs to alleviate symptoms.

We're also learning in incredible detail the character of the Sars-CoV-2 package. A propensity to antigenic drift and/or shift may mean a vaccine is seeking a moving target - and the Wuhan virus may become an annual visitor, and just as we take a quad-vaccine flu shot each season betting on the four strains most likely to emerge in any year, we will have annual Wuhan shots with two or three likely variations included. However, unless something miraculous happens, no vaccine will be here before next year. And that means we must take a hit before then. And in the worst case, there may be no acquired immunity and no vaccine at all.

That's the bottom line for every nation. Lift lockdowns now to allow the Wuhan bug to climb to an R0 of say R1.05, just enough to be able to pinch it off once maximum NHS capacity is reached, and allow the economy to live. And if there's no acquired immunity, then the Wuhan virus will become a deadly variation of the common cold, one that carries-off an additional 100,000 UK citizens a year, and it will change forever the way we live.

Right now the energy, ingenuity and application of the chaotic anarchy of scientific research and scholarly internet publication is coming each day closer to letting us know the score. They're quite capable of filtering-out the snake oil, and we should be cautious of any pharma company claiming to have a miracle drug. If I clap anyone today, it will be those internet research heroes, the doctors and scientists delivering data and research hot on our screens each day.

Wednesday 29 April 2020

Licence plate lockdown

Unlike UK licence plates, which belong to a particular car, Austrian plates are issued to an insured driver by the insurance companies on behalf of the government. They are yours, and can be used on up to three cars - you only pay an insurance premium for the most expensive. They clip and unclip from their mountings quite easily. But because they belong to the insured person, it is possible for each registration number to carry a residence-specific code portion, along with the wappen or arms of your Bundesland . If you move to a different Bezirk (think of it as about equivalent to a district council) you need to get a new licence plate.

A plate belonging to someone from Klagenfurt, in the state of Kärnten

If such a scheme were run in the UK, the first two letters of the licence plate would indicate your place of residence. For London, it would be a London shield symbol plus a borough code - say LA for Lambeth, WE for Westminster, BR for Bromley and so on. Any 'county lines' drug dealers here have a very hard time - but that's not all.

Country areas are naturally suspicious of outsiders even in good times, and the Wuhan virus has magnified mistrust of any vehicle with a 'foreign' licence plate - and by foreign, I mean a vehicle from a neighbouring district, never mind out-of-state vehicles or the Satanic chariots carrying the evil W for Vienna. Believe me, after a while non-local vehicles stick out like a sore thumb in the supermarket car park - and you can be sure if a car with plates bearing the shield of Tyrol and LA code that includes Ishgl, the seat of Austria's après-ski contagion, were spotted there the store doors would have been locked shut. 

I'm fascinated to learn how the locals will cope with the end-of-lockdown dilemna. They will be riven between mistrust of the outsider and the welcoming of the critical summer tourist Euros. It will be fun to watch. 

And second-homers in the UK can be very grateful for the anonymity of UK licence plates.

Tuesday 28 April 2020

Deaths - all causes stats

The deaths - all causes stats are the ones to watch today. Looking at the shape of pandemic death curves, those that include all excess deaths at a time of pandemic, they seem to have a longer tail. Thus when the first 6k figure was released, I speculated a rough path would be a 6 - 15 - 8 - 4 shape, giving some 33k excess deaths for the first wave of the Wuhan virus. So far we've had 6 - 18. If my initial guess at the shape was right, we could be on a 6 - 18 - 10 - 5 trajectory.

The shape of the first wave is important as it can give us a clue as to the likely outcome of a second, enhanced wave. It seems we're going to have to take the hit, whatever happens. Neither the economy nor public order will survive an indefinite total lockdown, and people are voting with their feet.

The first wave of the 1918 Spanish flu pandemic caused a fatality peak in mid-July, the second a fatality peak in mid-November, some four months later. The second peak was much bigger in 1918 - if 18k is the Wuhan first peak, the second would be 90k in the highest week if un-modified. That, of course, is what the government is desperate to avoid.

I think we'll need to keep those empty Nightingale hospitals open for the foreseeable future, in any event. 

Last week's excess deaths for all UK wasn't 18k but 17k. This week's (week 16) gives 11,854 excess deaths in E&W above 5 year average, 844 in Scotland and 134 in NI. 12,832 in total. So the pattern so far is 6 - 17 - 13, as far as I can see. 

Monday 27 April 2020

A damning indictment of Whitehall's public health failure

The smug complacency of the Whitehall establishment prior to the impact of the Wuhan virus was sickening. They were - and are - convinced that gross centralisation is the answer to everything, but C19 has proven the fallaciousness of this delusion.

This country has had a long history of response to threats to public health, from Snow's cholera-infected Soho pump in 1854 onwards. We had local boards of health, and medical officers of health, one for each local government area. They ensured that adequate provision was made for burials, clean water, sewers and other public health infrastructure - but above all they were the nation's first line of defence against epidemics. Cholera, Typhoid, TB, Diphtheria. Being 'modern' is no defence against zoonotic or parasitic epidemics - as this paper, describing the challenges to public health post-1945 in Germany, describes -
... the following years were characterized by deficiencies of hygiene which had not occurred previously in Middle Europe during the 20th century. There were focuses of typhus, typhoid fever, tuberculosis, diphtheria, scarlet fever, and meningitis. Insufficiencies in the removal of faeces caused high incidences of shigellosis, hepatitis A, and ascariasis. As a result of insufficient body care, many people were infested with fleas, lice and scabies. The migration of large proportions of the population resulted in an increasing prevalence of syphilis an gonorrhea.
Our experiences in liberated Europe renewed our commitment to local public health, and a generation of Medical Corps officers who dealt with these conditions at first hand moved into environmental and public health positions in local government. For many years we benefited from their experience. The Guardian takes up the story from this point;
The system of local communicable disease control was established in the 19th century. After the NHS was set up in 1948, it was supported in England and Wales by national, regional and more than 40 local public health laboratories. But since local medical officers of health were abolished in 1974 – replaced by community physicians at different levels of the NHS – the system has been gradually but relentlessly eroded, fragmented and centralised.

Communicable disease control was centralised in the Health Protection Agency in 2003, and local public health laboratories transferred to NHS hospitals. Public health was then carved out of the NHS in England in the 2012 Health and Social Care Act, which abolished local area health bodies, created Public Health England to fulfil the government’s duty to protect the public from disease and charged local authorities with improving public health – but with limited proactive scope for infectious disease control and woefully inadequate resources.
The woeful failures of Public Health England, which we have catalogued, are not the only consequences of woke centralisation. PHE effectively abandoned their responsibilities for epidemic control, implemented an unworkable and ineffective central system and concentrated their resources on the faddish obsessions of the middle-class woke well - smoking, alcohol and sugar. As the authors of that Guardian piece also point out, the concentration on NHS 111 - telephone helplines that simply collapsed under the weight of hundreds of thousands of anxious callers - left local GPs with direct local knowledge completely unused.

The utter abandonment of their key responsibilities has not been the only negligent direction that PHE has taken. As John Ashton reported to the Telegraph, PHE officials have run up 5.1 million air miles over the past 3 years on 'the global health security agenda'. It's easy to see what's happened. They've utterly neglected their fundamental local public health responsibilities in favour of quasi-academic junkets to Florida or Singapore, business class travel and international hotels on the public purse, when they should have had their heads down sewer-covers in Birmingham. As Ashton, a former Director of Public Health, comments carefully "PHE's time would have been better spent ensuring testing facilities were up to scratch throughout the country" he said. "It's been inadequate and they have failed to catch up with themselves even when it was shown to be inadequate," he told The Telegraph.

We must keep pushing the absolute necessity for localisation and decentralisation. We must keep exposing the manifold failures of the central Whitehall machine. They are costing lives.

Levels of TB in London greater than Iraq, Ethiopia or Afghanistan are a damning public health indictment

Sunday 26 April 2020

West moves to Phase II of Wuhan virus response

At slightly different speeds and in slightly different ways, the nations of the Western world are now moving together into Phase II of their response to the Wuhan virus. How hard lockdowns are being lifted will vary according to local conditions, but we now have confidence that the toll from the bug can be controlled if necessary. Now we know the brakes work, it's time to take our foot from the brake pedal.

It will change our behaviour for ever, just as AIDS did in the early '80s. Even if the Wuhan virus proves a great deal less lethal and much less transmissible - it's native R0 of ~2.3 is around half that of ~4.6 for AIDS - its character may mean that we must protect the old and vulnerable whilst the rest of us carry on as normal, polarising society. Grandparents would be separated from their grandchildren, the morbidly obese would need either to lose weight or adopt leper lifestyles and the immunocompromised remain behind closed doors.

Pressure will now be intense on the world's indigenous peoples to stop eating bats and monkeys - too many novel diseases have sprung from this practice, distasteful to Western tastes, since jet travel and increased prosperity enabled enhanced transmission. And China must stop sending her diplomats to lie and evade responsibility for the Wuhan virus; listen if you will to Friday's World at One interview with Chen Wen, China's deputy ambassador to the UK (from about 11:06 to 28:30). It's a stunning display of authoritarian delusion. No wonder the government have now removed the China line from the daily Covid-TV graphs - it's pure fiction. She also denied that China had any 'wet' markets at all that sold bats, beavers, badgers and other wild animals, dead and alive - not so she said. China had farmers' markets, which sold fresh meat and vegetables. Well, I've been to Blackheath farmers' market a few times and have never found live eating-snakes and Pangolin chops on the stalls there. Tom Tugendhat is actually right about China - I just wish he was a little more articulate and animated about it. And it's not just China. Africans must either close down their bushmeat markets or their visitors must face a month's quarantine before those wealthy corrupt ministers' wives, fat as butter, can spend their stolen cash in Bond Street.

Phase II will also introduce enhanced national security measures not unrelated to our having left the EU. Our waters and the fish that dwell in them have now become a national security asset in a way they weren't in December. There is zero chance that we'll now trade away even a scintilla of control. The new quarantine requirements for visitors will become a permanent feature - at least the requirement for visitors to register an address, for track-and-traceability. No great novelty there for anyone who knows Europe and has completed a fiche or meldezettel at a hotel or rented villa.

As for forecasts that Phase II will see the demise of cash - I'm not convinced. Oh for sure, our steel and nickel coins and plastic and paper notes are filthy, but that hasn't always been the case. Both silver and copper have strong antiviral properties, and I'm sure it is not beyond the wit of man to incorporate silver or copper ions in banknote 'paper'. Till-draw cavities could also be internally flooded in UV to allow constant viral destruction. Cash expresses our freedom from absolute State control, and we'd be foolish to allow it to be taken from us even at this time.

The debates, the research, the policy trials and errors will continue into Phase II. We don't yet have the answers, but we approach the next stage with greater confidence in ourselves and our abilities. Let's just ensure the world on the other side is a better one, albeit a different one, to that in 2019.